Individual
KATHERINE VESTAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24988 SE STARK ST STE 220, GRESHAM, OR 97030-8324
(503) 674-1580
Mailing address
PO BOX 4365, PORTLAND, OR 97208-4365
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA217362
OR
Other
Enumeration date
01/04/2022
Last updated
05/06/2024
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